EEGULATIONS 


MEDICAL  DEPARTMENT 


MILITARY  FORCES 


x\ORTH  CAROLINA. 


riBLisHEn  nv 

CHAS.  E.  JOHNSON,  M.  D., 

SURGEON  GENERAL  OF  N.  C. 


V 


RALEIGH  : 

STUOTHi.K  *  ^I.VRCOM  BOOK  AND  JOB  PRINTERS. 


1  8G1 


(7>/A  ^37 


DUKE 

UNIVERSITY 

LIBRARY 


Treasure  %oom 


KEGULATIONS 


MEDICAL  DEPARTMENT 


1.  The  Surgeon  General,  under  the  authority  of  the  Gorernor, 
and  the  Military  Laws  of  the  State,  is  charged  with  the  adminis- 
trative details  of  the  Jledical  ])e{)artmcnt,  the  governiuent  of  hos- 
pitals, the  regulation  of  the  duties  of  Surgeons  and  Assistant  Sur- 
geons, and  the  assignment  of  Surgeons  or  Assistant  Surgeons,  where 
needed,  for  local  or  detached  service.  He  will  issue  orders  and 
instructions  relating  to  their  professional  duties,  and  all  communi- 
cations from  them,  which  rcfiuire  his  action,  will  be  made  directly 
ti)  him. 

2.  The  medical  supplies  ro(|uired  by  Surgeons  and  Assistant 
Surgeons  will  be  obtained  by  a  requisition  on  the  Surgeon  General, 
a  duplicate  of  the  requisition  of  the  Surgeon  or  Assistant  Surgeon 
being  furnished  to  be  filed. 

3.  When  a  medical  officer  transfers  medical  supplies  to  another, 
or  to  a  different  post,  he  will  take  a  receipt  for  the  Bame. 

4.  Medical  officers  will  account  for  all  medical  supplies  that  come 
into  their  possession. 

5.  The  .senior  medical  officer  of  a  hospital  will  distribute  the 
patients,  according  to  convenience  and  the  nature  of  their  com- 
plaints, into  wards  or  divisions,  under  the  particular  charge  of  the 
Assistant  Surgeons,  and  will  visit  them  himself  each  day,  as  fre- 
quently as  the  sick  or  wounded  may  require,  accompanied  by  the 
Assistant,  Hospital  Steward  and  Nurse. 

6.  His  prescriptions  of  medicine  and  diet  arc  daily  to  bo  written 
down  in  a  register,  with  the  name  of  the  patient  and  number  of  the 
bed;  and  the  Assistant  or  Steward,  in  his  absence,  will  see  that  the 
directions  are  carried  out. 


4  MEDICAL    REOULATIOXS. 

7.  He  will,  if  ill  charge  of  a  hospital  or  post,  with  the  approval 
of  the  ommandiiig  fifBeer,  appointa  steward,  cooks  and  nurses,  who 
will  be  uiulcr  his  orders. 

8.  lie  will  enforce  the  proper  hospital  regulations  to  promote 
health  and  prevent  contagion,  hy  ventilated  and  not  crowded  rooms, 
scrupuliius  cleanliness,  changes  of  bed,  linen,  &c. 

9.  At  the  Surgeon's  call  the  sick  in  each  corapan\-  will  be  con- 
ducted to  the  hospital  by  the  First  Sergeant,  who  will  hand  to  the 
Surgeon  in  his  company  book  a  list  of  all  the  sick,  on  which  list  the 
Surgeon  shall  state  who  are  to  remain  or  go  into  hospital ;  who  arc 
to  return  to  quarters  as  sick  or  convalescent;  what  duties  the  con- 
valescents in  quarters  are  capable  of,  or  any  other  information  in 
regard  to  the  sick  of  the  company  which  he  may  have  to  communi- 
cate to  the  commander,  and  report  to  him.     (Form  1.) 

10.  Soldiers  in  hospital,  patients  or  attendants,  except  stewards, 
shall  be  mustered  on  the  rolls  of  the  hospital  department. 

11.  When  a  patient  is  transferred  from  one  hospital  to  another, 
the  medical  officer  shall  send  with  him  an  account  of  his  case  and 
the  treatment.     (Form  4.) 

12.  The  regulations  for  the  service  of  hospitals  apply  as  far  as 
practicable  to  the  service  in  the  field. 

13.  The  senior  medical  officer  of  each  hospital,  post,  regiment  or 
detachment,  will  keep  the  following  records:  a  register  of  patients 
(Form  2;)  a  prescription  and  diet  book  (Form  3;)  a  case  book; 
copies  of  his  reiiuisitions;  monthly  returns  of  sick  and  wounded; 
an  order  and  letter  book,  in  which  will  be  transcribed  all  orders  and 
letters  relating  to  his  duties. 

14.  Ordinarily,  hospital  attendants  are  allowed  as  follows:  to  a 
general  hospital,  one  steward,  o'ne  nurse  to  ten  patients,  and  (me 
cook  to  thirty;  to  a  post  or  garri.son  of  one  company,  one  steward, 
one  nurse,  one  cook  and  for  every  two  companies  more,  one  nurse. 

lo.  Medical  officers,  in  giving  certificates  of  disability,  are  to  take 
particular  care  in  all  cases  which  have  been  under  their  charge, 
and  especially  in  epilepsy,  convulsions,  chronic  rheumatism,  gout, 
dcranaeineiil  of  ihc  urinary  orjians.  (iplitlialiiiia.  iiliers.  or  any  ob- 
scure disi'ascs. 

16  As  .soon  as  companies  are  organizeil  and  ofl'ered  for  service, 
the  Surgeon  or  Assistant  Surgeon  will  examine  the  members  and 
vaccinate  them,  if  necessary. 


MEDICAL    UE(U'I,ATIOSS.  5 

17.  Every  medical  officer  will  report  to  the  Surgeon  General  the 
date  when  he  arrives  at  a  station,  or  when  he  leaves  it.  and  his 
orders  in  the  ca.sc. 

18.  Surgeons  will  make  to  the  Surgeon  General  a  monthly  return 
(Form  7)  of  the  medical  officers  of  the  Command,  and  a  consoli- 
dated monthly  report  of  the  sick  and  wounded  from  the  several 
reports  made  to  them ;  giving  the  disease,  name,  regiment  and  com- 
pany, discharges  and  deaths.  (Form  5.)  ALso  a  return  of  medi- 
cines, instruments,  hospital  stores,  furniture,  &c.     (Form  G.) 

It).  If  it  be  at  any  time  necessary  to  employ  a  private  physician, 
the  commanding  officer  may  do  it  liy  written  contract,  reporting  a 
duplicate  to  the  Surgeon  General. 

20.  Assi.stant  Surgeons  will  obey  the  orders  of  their  Senior  Sur- 
geon; see  that  subordinate  officers  do  their  duty,  and  aid  in  en- 
forcing the  regulations  of  the  hospital. 

21.  The  Steward  will  take  charge  of  all  hospital  stores,  instru- 
ments, furniture  of  every  description,  a.. d  supplies  for  the  sick; 
keep  a  roster  of  nurses  and  attendants  ;  and  make  out  returns  Air 
rations,  according  to  the  number  in  hospital;  receive  and  distribute 
rations,  and  submit  his  book  to  the  Surgeon,  monthly,  for  examina- 
tion, or  oftcner  if  required,  lie  will  issue  the  stores  to  nurses  and 
cooks,  and  enter  the  amount  delivered  in  his  hook.  He  will  fee  re- 
sponsible for  furniture,  bedding,  cooking  utensils,  &c.,  and  keep  the 
store-room  neat  and  clean.     (Form  G.) 

22.  In  the  management  of  hospitals  and  posts,  cleanliness,  order, 
regularity  in  meals,  attention  to  cooking,  and  special  care  of  the 
sick  and  wounded,  are  particularly  enjoined  upon  the  medical  officers. 

23.  In  pa.ssing  a  recruit,  the  medical  officer  is  to  examine  him 
stripped;  to  see  that  he  has  free  use  of  all  his  limbs  ;  that  his  chest 
isam])le;  that  his  hearing,  vision,  and  s]iccch  are  perfect;  and  that 
he  is  nut  suHorlng  from  any  disorder  or  infirmity  that  may  unfit 
him  for  militarv  service. 


MEDICAL    RElilL.VTIOXS. 


giitctiouji  to  glnniJ  ^urgcon.'j. 

(FROM  A  PAMPHLET  ON  THE  HOSPITAL  BRIGADE.) 

BY  G.  J.  GUTnUIE, 

Surjrcon  General  to  the  British  forces  in  the  Crimean  War. 


1.  Water  being  of  the  utmost  importance  to  wounded  men.  care 
should  be  taken  when  before  the  enemy,  not  only  that  the  barrels 
attached  to  the  conveyance-carts  are  properly  filled  with  good  water, 
but  that  skins  for  holding  water,  or  such  other  means  as  are  com- 
monly used  in  the  country  fur  carrying  it,  should  be  procured  and 
duly  filled. 

2.  Bandages  or  rollers,  applied  on  the  field  of  battle  are.  in  gen- 
eral, so  many  things  wasted,  as  they  become  dirty  and  stiff,  and  are 
usually  cut  away  and  destroyed,  without  having  been  really  u.seful; 
they  are  therefore  not  forthcoming  when  reijuired,  and  would  be  of 
no  use. 

3.  Simple  gun-shot  wounds  require  nothing  more,  for  the  first 
two  or  three  days,  than  the  application  of  a  piece  of  wet  or  oiled 
linen,  fastened  on  with  a  strip  of  sticking-plaster,  or,  if  possible, 
kept  constantly  wet  and  cold  with  water.  When  cold  disagrees, 
warm  water  should  be  substituted. 

4.  Wounds  made  by  swords,  sabres,  or  other  sharp-cutting  instru- 
ments, are  to  be  treated  principally  by  position.  Thus,  a  cut  down 
to  the  bone,  across  the  thick  part  of  the  arm,  immediately  below  the 
shoulder  is  to  be  treated  by  raising  the  arm  to  or  above  a  right  angle 
with  the  body,  in  which  po.sition  it  is  to  be  retained,  however  in- 
convenient it  may  be.  Ligatures  may  be  inserted,  but  through  the 
skin  only.  If  the  throat  he  cut  acmss  in  front,  any  great  vessels 
should  bo  tied,  and  the  oozing  stopped  by  a  sponge.      .Xfter  a  few 


MEDICAL    KEUULATIOX:*.  ( 

hours,  when  the  oozing  is  arrested,  the  spon-ic  should  be  removed, 
and  the  head  brought  down  towards  the  chest,  and  retained  in  that 
position  without  ligatures ;  if  this  is  done  too  soon  the  sufferer  way 
possibly  be  suffocated  by  the  infiltration  ot  blood  into  the  areolar 
tissue  of  the  parts  adjacent. 

5.  If  the  cavity  of  the  chest  is  opened  into  by  a  sword  or  lanee, 
it  is  of  the  utmost  importance  that  the  wound  in  the  skin  should  be 
effectively  closed,  and  this  can  only  be  done  by  sewing  it  up  as  a 
tailor  or  a  lady  would  sew  up  a  seam,  skin  only  being  included;  a 
compress  of  lint  .should  be  applied  over  the  stitches,  fastened  on  by 
sticking  plaster.  The  patient  is  then  to  be  placed  on  the  wounded 
side,  that  the  lung  may  fall  down,  if  it  can,  upon,  or  apply  itself  to 
the  wounded  part,  and  adhere  to  it,  by  which  happy  and  hoped-for 
accident  life  will,  in  all  probability,  be  preserved.  If  the  lung 
should  be  seen  protruding  in  the  wound,  it  should  not  be  returned 
beyond  the  level  of  the  ribs,  but  be  covered  over  by  the  external 
parts. 

6.  It  is  advisable  to  encourage  previously  the  discharge  of  blood 
from  the  cavity  of  the  chest,  if  any  have  fallen  into  it;  but  if  the 
bleeding  from  within  should  continue,  so  as  to  place  the  life  of  the 
sufferer  in  danger,  the  external  wound  should  be  closed,  and  events 
awaited. 

7.  When  it  is  doubtful  whether  the  bleeding  proceeds  from  the 
cavity  of  the  chest,  or  from  tl^  intercostal  artery  (a  surgical  bug- 
bear,) an  incision  through  the  skin  and  the  external  intercostal 
muscle  will  expose  the  artery  close  to  the  edge  of  the  rib  having 
the  internal  intercostal  muscle  behind  it.  The  vessel  thus  exposed 
may  be  tied,  or  the  end  pinched  by  the  forceps,  until  it  cca.<<es  to 
bleed.  Tying  a  string  round  the  ribs  is  a  destructive  piece  of 
cruelty,  and  the  plugs,  &c.,  formerly  recommended,  may  be  consid- 
ered as  surgical  incongruities. 

8.  A  gun-shot  wound  in  the  chest  cannot  close  by  adhesion,  and 
must  remain  open.  The  position  of  the  sufferer  should  therefore 
be  that  which  is  most  comfortable  to  him.  A  small  hole  penetrating 
the  cavity  is  more  dangerous  than  a  large  one,  and  the  wound  is 
less  dangerous  if  the  ball  goes  through  the  body.  The  wounds 
should  be  examined,  and  enlarged  if  necessary,  in  order  to  remove 
all  extraneous  substances,  even  if  they  should  be  seeh  to  stick  on 


8  MEDICAL    niXiULATIOXS. 

the  surface  of  tlic  lungs;  the  opening  should  be  covered  with  soft 
oiled  or  wet  lint — a  bandage  when  agreeable.  The  car  of  the  sur- 
geon and  the  stethoscope  are  invaluable  aids,  and  ought  alwaj's  to 
be  iu  use;  indeed,  no  injury  of  the  chest  can  be  scientifically  treated 
without  them. 

9.  Incised  and  gun-shot  wounds  of  the  abdomen  are  to  be  treated 
in  ncnrli/  a  similar  manner;  the  position  in  both  being  that  which 
is  most  agreeable  to  the  patient,  the  parts  being  relaxed. 

11.  In  wounds  of  the  bladder,  an  elastic  catheter  is  generally 
necessary.  If  it  cannot  be  passed  an  opening  should  be  made  in  the 
perinseum  for  the  evacuation  of  the  urine,  with  as  little  delay  as 
possible. 

12.  In  gun-shot  fractures  of  the  skull,  the  loose  broken  pieces 
of  bone,  and  all  extraneous  substances  are  to  be  removed  as  soon  as 
possible,  and  depressed  fractures  of  bone  are  to  be  raised.  A  deep 
cut  made  by  a  heavy  sword  through  the  bone  into  the  brain,  gener- 
ally causes  a  considerable  depression  of  the  inner  table  of  tlie  bone, 
whilst  the  outer  may  appear  to  be  merely  divided. 

13.  An  arm  is  rarely  to  be  amputated,  except  from  the  effects  of 
a  cannon-shot.  The  head  of  the  bone  is  to  be  sawn  off,  if  necessary. 
The  elbow-joint  is  to  be  cut  out,  if  destroyed,  and  the  sufferer,  in 
either  case,  may  have  a  very  useful  arm. 

ll.  In  a  ease  of  gun-shot  fracture  of  the  upper  arm,  in  which  the 
bone  is  much  splintered,  incisions  are  to  be  made,  for  the  removal 
of  all  the  broken  pieces  which  it  is  feasible  to  take  away.  The 
elbow  is  to  be  supported.  The  forearm  is  to  be  treated  in  a  similar 
manner;  the  splints  used  should  be  solid. 

15.  The  hand  is  never  to  be  amputated,  unless  all  or  nearly  all 
its  parts  are  destroyed.  Different  bones  of  it  and  of  the  wrist  are 
to  be  removed  when  irrecoverably  injured,  with  or  without  the 
metacarpal  bones  and  fingers  or  the  thumb;  but  a  thumb  and  one 
finger  should  always  be  preserved  when  possible. 

16.  The  head  of  the  thigh  bone  should  be  sawn  oft"  ^vhen  broken 
by  a  musket-ball.  Amputation  at  the  hip-joint  should  only  be  done 
when  the  fracture  extends  some  distance  into  the  shaft,  or  the  limb 
is  destroyed  by  cannon-shot. 

17.  The  knee-joint  should  be  cut  out  when  irrceovcrably  injured; 
but  the  limb  is  not  to  be  amputated  until  it  cannot  be  avoided. 


MliDKAL    KKlJl  LATIOXS.  9 

18.  A  gun-shot  fracture  of  the  nruidle  of  the  tliiirh.  iittcnilud  by 
great  splintering,  is  a  case  for  amputation.  In  less  difficult  case.-", 
the  splinters  should  be  removed  by  incisions,  particularly  when 
they  can  be  made  on  the  upper  and  outer  .side  of  the  thigh.  The 
limb  should  be  placed  on  a  straight,  firm  splint.  A  broken  thigh 
does  not  admit  of  much,  and  sometimes  of  no  extension,  without  an 
unadvisablc  increase  of  sufTering.  An  inch  or  two  of  shortening  in 
the  thigh  docs  not  so  materially  interfere  with  ]irogrcssion  as  to 
make  the  sufferer  regret  having  escaped  amputation. 

19.  A  leg  injured  below  the  knee  .should  rarely  be  amputated  in 
the  first  instance,  unless  from  the  effects  of  a  cannon-shot.  The 
splinters  of  bone  arc  all  t<i  be  immediately  removed,  bv  saw  or 
forceps,  after  due  incision.*.  The  limb  should  be  placed  in  splints, 
and  hung  on  a  permanent  frame,  as  affording  the  greatest  eomi'ort. 
and  probable  chance  of  ultimate  success. 

20.  An  ankle-joint  is  to  be  cut  out.  unless  the  tendons  around 
are  too  much  injured,  and  so  are  the  tarsal  and  metatarsal  bones  and 
toes.  Incisions  have  hitherto  been  too  little  eni]iloyed  in  the  early 
treatment  of  these  injuries  of  the  foot  for  the  removal  of  extraneous 
substances. 

21.  A  Wound  of  the  principal  artery  of  the  thigh,  in  addition  to 
a  gun-shot  fracture,  renders  immediate  aniput.ation  necessary.  In 
no  iithfr  jKiit  of  the  body  is  amputation  to  be  done  in  the  first  in- 
stance for  such  injury.  Ligatures  arc  to  be  placed  on  the  wounded 
artery,  one  above,  the  other  below  the  wound,  and  events  awaited. 

22.  The  occurrence  of  mortification  in  any  of  these  cisos  will  be 
known  by  the  change  of  color  in  the  skin.  It  will  rarely  occur  in 
the  upper  extremity,  but  will  fieiiuently  do  so  in  the  lower.  When 
about  to  take  place,  the  C(dor  of  the  skin  of  the  foot  changes,  from 
the  natural  flesh  color  to  a  tallowy  or  mottled  white,  .imputation 
should  be  performed  immediately  above  the  fractured  part.  The 
mortification  is  yet  local. 

23.  When  this  discoloration  lia.s  not  been  observed,  and  the  jiart 
shrinks,  or  gangrene  ha.s  set  in  with  more  marked  appearances,  but 
yet  seems  to  have  sfnjyinl  at  the  ankle,  delay  is,  perhaps,  admissible, 
but  il'  it  should  again  spread,  or  its  cessation  be  doubti'ul,  amputa- 
tion shoulil  take  place  forthwith,  although  under  less  favorable 
circumstances.  The  mortification  is  becoming,  or  ha.<  1  ecome  con- 
slitulional. 


10  -MKUICAi,    KKOiLLATIOXS. 

24.  IJlccJiiiL'.  to  the  loss  of  life,  is  not  a  cominoi)  occurreiK-e  in 
uuii-sliot  wounds,  althouu'li  many  do  lileed  considerablj-,  seldom, 
however,  reijuirinc:  the  application  of  a  tourni(|UCt  a.s  a  matter  of 
necessity,  although  frequently  a.s  one  of  jjreeaution. 

25.  AVhen  the  great  artery  of  the  thigh  is  wounded  (not  torn 
across),  the  bone  being  nninjiirfil.  the  suflVrer  will  probably  bleed 
to  death,  unless  aid  be  afforded,  by  making  coin])ression  above,  and 
on  the  bleeding  part.  A  long,  but  not  broad  stone,  tied  sharply  on 
*vith  a  handkerchief,  will  often  suffice  until  a.«sistanee  can  be  ob- 
tained, when  both  ends  of  the  divicbil  ur  wonnded  artery  are  to  be 
secured  by  ligatures. 

26.  The  upper  end  of  the  great  artery  of  the  tliigh  bleeds  scarlet 
blood,  the  lower  end  dark  venous-colored  blood;  and  this  is  not 
departed  from  in  a  case  of  accidental  injury,  unless  there  have  been 
previous  diseases  in  the  limb.  A  knowledge  of  this  fact  or  cir- 
cumstance, which  continues  for  several  days,  will  jjrcvent  a  mistake 
at  the  moment  of  injury,  and  at  a  subsequent  period,  if  secondary 
hajuinrrbage  should  occur.  In  the  tipper  extremity  both  ends  of 
the  principal  artery  bleed  scarlet  blood,  from  the  Iree  collateral 
circulation,  and  from  the  anastomoses  in  the  hand. 

27.  From  this  cause,  mortification  rarely  takes  place  after  a  wound 
of  the  principal  artery  of  the  arm,  or  even  of  the  arm-pit.  It 
freqnmtlji  follows  a  wound  of  the  principal  artery  in  the  upper, 
middle,  or  even  lower  pai-ts  of  the  thigh,  rendering  amputation  ne- 
cessary. 

28.  It  is  a  great  question  when  the  bone  is  iininjiircil,  where,  and 
at  what  part,  the  amputation  should  be  performed.  Mortiticatiou 
of  the  foot  and  leg,  from  such  a  wound,  is  disposed  to  stop  a  little 
below  the  knee,  if  it  should  not  destroy  the  sufferer;  and  the  ope- 
ration, if  done  in  the  first  instance,  as  soon  ns  the  tallowy  or  mot- 
tled appearance  of  the  foot  is  observed,  should  be  doneat  that  part; 
the  wound  of  the  artery,  and  the  operation  for  securing  the  vessel 
above  and  below  the  wound,  being  left  unheeded.  By  this  proceed- 
ing when  successful,  the  knee-joint  is  saved,  whilst  an  amputation 
above  the  middle  of  the  thigh  is  always  very  doubtful  in  its  result. 

29.  When  mortification  has  taken  place  from  any  cause,  and  has 
been  arrested  below  the  knee,  and  the  dead  parts  show  some  sign 
of  separation,  it  is  usual  to  amputate  above  the  knee.     By  not  doing 


MEmCAL    UECirLATIOXS.  11 

it,  but  by  gradually  separating  and  removing  the  dead  parts  under 
the  use  of  disinfecting  nicdieaments  and  fresh  air,  a  good  stump 
may  bo  ultimately  made,  the  knee-joint  and  life  being  preserved, 
which  latter  is  frequently  lost  after  amputation  under  such  circum- 
stances. 

30.  Hospital  gangrene,  when  it  unfortunately  occurs,  should  be 
considered  to  be  contagious  and  infectious,  and  is  to  be  treated 
locally  by  destructive  remedies,  such  as  nitric  acid,  and  (he  bivou- 
acking or  encamping  of  the  remainder  of  the  wounded,  if  it  can  be 
cflcctcd  or  their  removal  to  the  open  air. 

31.  Poultices  have  been  very  often  ap|)licd  in  gun-shot  wounds, 
from  laziness,  or  to  cover  neglect,  and  should  be  used  as  seldom  a.s 
possible. 

32.  ('hlori)forin  may  be  administered  in  all  ca.ses  of  amputation 
of  the  upper  extremity  and  below  the  knee,  and  in  all  minor  opera- 
tions; which  cases  may  also  be  deferred,  without  disadvantage,  until 
the  more  .serious  operations  are  performed. 

33  Amputation  of  the  upper  and  middle  parts  of  the  thigh  are 
to  be  done  as  soon  as  possii)lo  after  the  receipt  of  the  injur_y.  The 
adminislration  of  chloroform  in  them,  when  there  is  much  prostra- 
tion, is  doubtful,  and  must  be  attended  to.  and  observed  with  great 
care.  The  ((Uestion  whether  it  should  or  should  not  be  administered 
in  such  cases  being  undecided. 


i 


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OR  QUANTITIES. 

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MEDICAL    REGULATIONS. 


21 


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The  remarks  will  state  the 
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Surgeon. 

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